Individual
MR. JONATHAN RICHARD TARDIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2935 SW CEDAR HILLS BLVD, BEAVERTON, OR 97005-1342
(503) 352-6000
Mailing address
PO BOX 568, CORNELIUS, OR 97113-0568
(503) 352-8657
(503) 352-8658
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500630150
—
OR
Enumeration date
11/15/2010
Last updated
10/14/2015
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